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To the Editor: Dr Bradley and colleagues¹ evaluated the relationship between hospital compliance with process measures for acute myocardial infarction (AMI) and short-term cardiac mortality. The data demonstrate that compliance with Joint Commission on Accreditation of Healthcare Organizations and the Center for Medicare and Medicaid Services core process measures can account for about 6% of the variation in outcomes for this patient population. We believe that their suggestion for expanded process measure reporting as a way to improve quality of care is not supported by the available evidence.

Public reporting of performance measures may disenfranchise high-risk patients.² Process measures may not be evidence-based and may reflect cost or political considerations. Examples include the selection of antibiotics for surgical infection prevention measures,³ the delayed adoption of a 48-hour stop time for prophylactic antibiotics following cardiac surgery despite data available from the Society of Thoracic Surgeons,⁴ and delayed acceptance of angiotensin-receptor blockers . . . [Full Text of this Article]

David McKalip, MD
dmckalip@neuro3.net
St Petersburg, Fla

Robert E. Harbaugh, MD
Department of Neurological Surgery
Penn State Milton S. Hershey Medical Center
Hershey, Pa

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